Acute demand isn't always linear. Census swings with the season, acuity changes day to day. Meanwhile, the departments under the most pressure are often the ones losing experienced nurses fastest.
In the 2026 NSI National Health Care Retention & RN Staffing Report, staff RN turnover climbed to 17.6%, reversing the prior year's decline, with behavioral health (22.5%), emergency (20.7%) and telemetry (19.5%) all running above the national average.
The demand behind those numbers isn't easing either: the Bureau of Labor Statistics projects registered nurse employment to grow five percent through 2034, faster than the average for all occupations, with roughly 189,100 RN openings a year.
The question for most hospital leaders isn't whether they'll rely on flexible coverage. It's what type of model they'll use to get it and whether it can move as fast as their census does.
The all-in-one promise and its trade-offs
For years the default answer has been the all-in-one workforce solution: a single enterprise system, usually a managed service provider paired with a vendor management system and a stack of travel contracts, that promises to pull every vendor, requisition and invoice under one roof. This type of consolidation might seem to make sense when you're managing a dozen agency relationships by spreadsheet.
But the convenience comes at the cost of control. To centralize coordination, the all-in-one model moves day-to-day decisions (such as which agencies see requests, who fills them, what you pay) into the program itself, behind minimum commitments, fixed-term contracts and the coordination layers that sit between the facility and the professionals who actually do the work.
These layers tend to add lag. The average hospital already needs more than two-and-a-half months to recruit an experienced RN and a rigid coverage model can add more delays on top of that.
The market is signaling the limits of the old approach. Traditional agency demand is shrinking: Staffing Industry Analysts reported travel nurse revenue fell 37% in 2024 and the per diem segment shrank 17%, while flexible, platform-based models are where demand is heading, citing independent professionals’ preferences for flexible models. Facilities are looking for a way off the treadmill, even as the all-in-one model proves hard to leave.
What a marketplace does differently
A technology marketplace comes at the same problems facing facilities but from a different direction. Instead of routing every request through an intermediary, it connects facilities directly with independent licensed professionals and lets the facility match coverage to real demand.
Coverage flexes with the census: with no minimums or long-term contracts, a facility posts the opportunities it actually needs and scales up or down to track volume and acuity, instead of committing to a fixed block of hours negotiated months earlier.
Selection stays with the facility. Professionals carry verified credentials and facilities can review credentials, ratings and reliability history before accepting a request, so full control is retained by the people who run a facility over who works in it.
Pricing is transparent up front so you can set the rate before posting the need, with no per-shift fee buried inside an agency markup and no surprises on the invoice.
Every layer between a facility and the professional who fills a shift is another handoff that could mean a round of emails, approvals and reconciliations for a team that's already stretched. Collapsing the approval chain into a direct connection gives time back to the schedule coordinators, the internal teams most exposed to the burnout the model is meant to relieve.
In an all-in-one program that supplies its own professionals, the entity managing your requests may have a stake in which professionals fill them. A marketplace has no such incentive: it connects facilities and independent professionals directly so the selection is based on individual fit, credentials and availability rather than on whose roster the coverage comes from.
Flexibility is the strategy
None of this means one model fits every facility. Some hospitals build the flexibility they need through internal float pools; others extend their teams with a technology marketplace when demand outruns what the core workforce can handle. What these workforce strategies share is the ability to flex.
That ability is also what keeps professionals in the field. In ShiftKey's Empowered Workforce Report, nearly one-third of independent professionals surveyed said they wouldn't be able to stay in healthcare at all without the schedule flexibility these models provide. Flexibility isn't just a perk for the workforce and a cost for the facility. It's a lever working on both sides of the shift.
As a technology marketplace, ShiftKey connects facilities directly with independent licensed professionals in their own communities: verified credentials, transparent pricing and real-time visibility included.
For acute teams weighing an all-in-one program against a more flexible model, that's the comparison worth testing: not which solution does the most, but which one bends when your demand does.
Frequently asked questions
What's the difference between a workforce marketplace and an MSP? An MSP manages your contingent workforce program on your behalf, usually coordinating outside agencies through a vendor management system. A workforce marketplace connects your facility directly with independent licensed professionals, so you post opportunities and select who fills them.
Does ShiftKey’s workforce marketplace require contracts or minimums? No. Facilities post the opportunities they need and pay only for shifts completed, without minimum commitments or fixed-term contracts.
Are marketplace professionals on the ShiftKey network local? Yes. ShiftKey’s marketplace draws on independent licensed professionals in the facility's own community, which supports continuity when the same professionals return.
How current is the nursing demand picture? Per BLS, RN employment is projected to grow faster than the average for all occupations through 2034, and NSI reports staff RN turnover rose to 17.6% in its most recent survey, so demand for flexible coverage is expected to persist.
Sources
“2026 National Health Care Retention & RN Staffing Report,” (NSI Nursing Solutions).
"The Cost of Nurse Turnover in 10 points," (Becker's Hospital Review, 2026).
“Occupational Outlook Handbook, Registered Nurses,” (U.S. Bureau of Labor Statistics).
"What lies ahead for Healthcare Staffing?" (Staffing Industry Analysts).
“Empowered Workforce Report,” (ShiftKey).
